Introduction

Important Issues in the
   Care of the Dying

Your “Job” in the Death and
   Dying Process

Hierarchy of the Dying
   Person’s Needs

Living with Spiritual Distress

Overview on Death from a
   Traditional Jewish Perspective

The Role of Culture and Diversity

Signs of Impending Death

Resources

Action Ideas That Work

“Real” Intersection of Systems

Helping Individuals Face   Important Decisions at the
  End of Life

Questions That are Good    Conversation Starters

Common Questions and Answers

Advance Care Planning

Advance Health Care Directive

Living Will

Durable Power of Attorney for
    Health Affairs

Hospice Care

Helping Survivors Deal With Grief

Questions and Answers About
    Health Care Directives

Handouts

References

Helping Individuals Face Important Decisions at the End of Life

Before beginning to discuss end of life issues, think about the individual’s prognosis, and his or her physical and emotional capacity for making decisions. You will want to strike a balance between the capacity of the person and the need for them to plan. Things to keep in mind:

• Can the person understand the available options?
• Does she use a consistent set of values in making decisions?
• Are financial concerns taking precedence in the planning process?
• What cultural tradition, rites and rituals are important to the person and family?
• Does the person isolated, lonely or hopeless, feeling that her life has already come to an end?
• Are decisions being made because he feels like a burden to others?
• Does she feel pressured by loved ones to make certain decisions?
• Are loved ones involved in the planning?

There are no definitive, established guidelines that congregational nurses can turn to when helping a person discuss end of life. However, there are common themes that you can help individuals and loved ones address, including:

• Use of medical intervention (ex. voluntary stoppage of eating or drinking, withholding or withdrawing treatment)
• Understanding disease progression
• Advance care planning [add link to section]
• Developing a will
• How the final days should be lived out
• Life review
• Role changes for the dying and their lived ones
• Completion of unfinished business

As a trusted care giver, helping individuals through these issues is a crucial role you play. The process of making these decisions is usually freeing and comforting for dying individuals. For instance, they will have a clearer understanding of how they want to approach the rest of their life, and what will make it worth living. They will feel more in control, as they will have made important decisions about what medical interventions they, not others, want in the future. And, they will typically have decreased fear of pain and loss of dignity. Overall, the process most often brings about better communication with loved ones, physicians, caregivers, and others important to the dying, as they come to have a shared understanding about the person’s values and wishes.

Don’t be discouraged if people do not immediately develop final advance care directives. Be hopeful that they have become familiar with the concept and rationale for advance care planning, and may take further steps toward completion in the future. Some patients will want to mull things over, others will want to discuss the topic with their close friends or family and health care providers. Fewer will be ready to sign documents and even fewer will be interested in personalizing their advance directives so that they are clear and contain pertinent information with clinical relevance.